The project objective is to develop a set of evaluative measures suitable for evaluating the performance of Emergency Medical Services systems and the quality of physician performance in this setting. This involves: 1) evaluation of the effectiveness of four evaluative process measures: direct observation, medical record review, resource utilization, and tracer studies; 2) development of a set of normative (panel) and empirical ("mode of practice") intervention criteria and their correlation to a normative healing curve expressed in the form of proximate outcomes; 3) establishment of the effectiveness of specific measures as predictors of outcome: severe score changes, resource utilization and specific objective tests; 4) development of an optimal cost-vaid set of measures for emergency medicine physician evaluation. Co-morbid and concomitant conditions present in the patient subgroup which manifests intervention patterns deviating significantly from the defined criteria, or whose healing curve (attainment of proximate outcomes) are significantly different from the norm, will be evaluated using these developed measures, with particular attention directed to the suspected alcohol abuse and suspected psychiatric disease groups. The significance of this proposal lies in its attempt to determine the discriminatory powers of various process measures in predicting intermediate and longer range patient outcomes, the comparison of these "outcome generated" performance criteria with traditionally developed arbitrary standards of care, and the identification of factors which are highly correlated with aberrations in emergency medical intervention patterns and patient outcomes.